The toll of twenty-six point two

At the starting line Sunday morning, Pitt students Kimberly Goehring and Shea McMurtry were worried their feet and ankles might not hold up.

Goehring and McMurtry lined up in the heart of downtown Pittsburgh with nearly 30,000 other registered runners for the Dick’s Sporting Goods Pittsburgh Marathon on Sunday. The two were both coming off of nagging stress fractures from when they were in high school and recent sprained ankles they sustained during training. While neither injured herself further during the race, both still understand the physical toll 26.2 miles can take on the human body.

To even run a marathon, the human body needs at least 2,600 calories for energy, according to Matthew Darnell, a certified nutritionist and assistant professor within the department of sports medicine and nutrition at Pitt. While health research on marathons doesn’t designate a specific mile-marker, several studies have found that intense and prolonged exercise, like running a marathon, can damage some individuals’ hearts. In 1987, Tim Noakes, a South African professor of exercise and sports science, found that 19 out of 36 people in a study of individuals who died with coronary artery disease suddenly died during, immediately after or 24 hours after running a marathon. Mortality aside, running a marathon is hard — and even harder with lingering injuries.

But back in January, Goehring and McMurtry weren’t thinking about injury. To prepare for the marathon, Goehring, a sophomore in Pitt’s pharmacy school and McMurtry, a junior exercise science major, both started training by running about five or six days per week, covering three to six miles per run, and saving the long run for the weekends. By the time the weather broke in the spring, McMurtry would run up to 18 miles.

This pattern — short runs nearly every day and a long run on the weekend — is standard for most marathon runners and few get injured following it. According to Nick Farina, who ran the Pittsburgh Marathon last year and the Boston Marathon this year, building up the long runs is important because runners start to really hurt their bodies after 20 miles.

Farina, a 2015 Pitt pharmacy grad, preferred this method. Farina finished Boston in two hours and 40 minutes. In his training, he started his short runs at six miles five or six days per week and his long runs at 10 miles on the weekends.

“Twenty miles is when your body starts getting in trouble,” Farina said. “That last six to seven miles is tough. Humans are not meant to run 26 miles.”

Despite the training pattern, Goehring sprained her ankle a few weeks before the marathon. She had finished her run for the day, she said, and was turning around to head home when her ankle buckled underneath her. When she made it home, she iced her ankle and kept it elevated for a few days. She was worried about injuring it again, she said, but would still run in the marathon on Sunday.

“I didn’t want all that to go to waste,” she said. “I put too much time into it. I don’t want my training to go to waste.”

She went to a doctor for treatment for her ankle, but didn’t mention she was planning on running the marathon. The doctor gave her “general advice” and a brace to wear for a few days so she didn’t injure her ankle further. On her way out the door, however, she did mention the marathon.

“So I probably shouldn’t run the marathon,” she said to the doctor.

Her ankle would take longer to heal, he said, but he gave her his permission.

“I was confident until I got injured, but I’m trying to keep a positive attitude,” she said before the race.

McMurtry, too, sprained her ankle while training, but a past injury, a stress fracture from when she was in high school, caused her more problems. While she was running for her high school’s cross country team, she suffered the fracture in the second metatarsal on her left foot and got bursitis, which is a type of inflammation in the joint that still causes her problems.

Her toe bone is too long genetically, she said, and because she kept running on it, she developed Morton’s Neuroma, which causes her foot to go numb when she runs. She can run when her foot is numb, but when it hurts too much, she has to stop.

For treatment, she went to a podiatrist, Brian Fullem, who suggested surgery to shorten her toe bone after the stress fracture, but she opted for physical therapy instead. There, the physical therapists tried to re-teach her how to run so she wouldn’t injure herself anymore, but for her, their treatment didn’t work.

“I never really learned how to run,” she said. “I just stopped physical therapy.”

Instead, Fullem, her podiatrist, custom-made her a pair of orthopedic shoes to help her toe heal. He also suggested she cross-train and vary her workouts to include hill training, lifting and bike riding, especially during the colder months.

According to Fullem, training for a marathon should be a gradual progression. One of the biggest risks runners take, he said, is increasing their mileage too quickly. It is important to build up the total numbers of miles run each week, he said, but increasing mileage by more than 10 percent per week can lead to injury. Ten percent is the magic number, meaning that if a runner runs a total of 30 miles one week, he or she shouldn’t run more than 33 miles the next week.

But injuries still occur, even if runners follow the 10 percent rule to the decimal place. The most important thing for physicians, Fullem said, is to treat the cause of injury, not just the symptoms. When they get injured, Fullem said, “people tend to just reach for the ibuprofen.”

“There’s never one magic bullet for an injury,” he said.

The most common injuries he sees are strains in the achilles tendon and medial pivotal stress pain, or, more simply, shin pain. But even when he sees patients with these injuries, he rarely tells them to stop running. Fullem is a runner himself, and has been since he was nine years old. The only time he advises someone to get off of their feet is when they’re limping.

When he was younger, he said, he tore his plantar fascia, the connective tissue on the bottom of the foot. The 18 months he couldn’t run were some of the hardest of his life, he said.

“It’s a lifestyle. It’s how you identify yourself,” Fullem said.

Because marathons are so hard on the body, it’s important for runners to keep up their nutrition, according to Darnell.

To optimize the body for running a marathon, Darnell said it’s important to train the cardiovascular system, the lungs especially, as well as bones, muscles and joints. It takes “a ton” of calories to propel a body for 26 miles, around 100 calories per mile depending on the individual, he said.

A runner’s primary fuel sources, he said, are carbohydrates and fats, like those found in pasta. Ideally, he said, runners should begin “carb packing” almost a week before the marathon.

The purpose of carb packing, Darnell said, is to maximize the intake of glycogen, a form of glucose that the body uses to power the muscles.

How much water a runner needs is dependent on how much they sweat. At the Marathon, volunteers handed finishers over 1,000 gallons of Gatorade in small paper cups.

At mile nine of the race, McMurtry said she wasn’t in any pain and was feeling like she was just going to have fun. But on the bridge from the South Side to Oakland, her foot went numb and she had to walk until she regained feeling. Once she did, she started running again. This occurred several times and slowed her down, she said.

Despite her sprain, Goehring’s ankle held up for the marathon. McMurtry said she had “never hurt this bad,” but both students finished. At mile 13, Goehring said she “hit the wall,” but still finished in 4:09. McMurtry finished in about 4:50.